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  • Title: [Endovenous thrombolysis in acute myocardial infarct. The experience in a community hospital. An analysis of 120 patients].
    Author: Jorge Sdo C.
    Journal: Arq Bras Cardiol; 1992 Jul; 59(1):23-30. PubMed ID: 1341143.
    Abstract:
    PURPOSE: To demonstrate the experience with thrombolytic therapy in a community hospital without a cardiac catheterization laboratory. METHODS: One hundred and twenty patients with EKG evidence of acute myocardial infarction with less than 6 hours of pain entered the study. They were retrospectively subdivided into two groups: group 1 (n = 96) received streptokinase and group 2 (n = 24) received rt-PA. RESULTS: One hundred and twenty patients were analysed. Ninety six (80%) received SK and 24 (20%) received intravenous rt-PA. Infarct side was anterior in 57 cases (47.5%) and inferior and/or lateral in 63 (52.5%). Coronary-angiography performed prior the discharge in reference hospital demonstrated patency of culprit vessel in 69 patients (80%) treated with SK and in 22 (91%) treated with rt-PA. According to clinical and angiographic data 60 patients (50%) were managed with medical treatment, 31 (25.8%) were submitted to angioplasty of the culprit artery and 29 (24.1%) underwent coronary bypass surgery. The complications were intracranial hemorrhage in 2 cases (1.6%), 1 post SK (1.0%) and 1 post rt-PA (4%); both of these patients died; reinfarction occurred in 4 patients and in 3 of them SK infusion was repeated successfully. There were no reinfarction in patients receiving rt-PA; major bleeding requiring blood transfusion occurred in 2 patients (1.6%); 1 patient developed hemothorax post SK and another one treated with rt-PA developed hematoma of left inferior limb. Eleven patients (9.1%) died during the hospital stay; 2 patients died of intracranial hemorrhage, 7 of cardiogenic shock and 2 had sudden death. The mortality rate in patient with anterior wall infarction was 15.7%, whereas it was significantly lower in the remaining patients (3.1%, p < 0.05). Only 4 patients over the age 75 received thrombolysis and 2 of them (50%) died. CONCLUSION: Intravenous thrombolytic therapy was safe and feasible in a community hospital without cardiac catheterization facilities. We observed only 2 fatal complications (1.6%) directly related to drug management (intracranial hemorrhage). The hospital mortality was 9.1%, including patient undergoing angioplasty of surgery following thrombolytic therapy.
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